Covid-19 - Vulnerable Highest Risk Patients (including Shielding)
CARING FOR PEOPLE AT HIGHEST CLINICAL RISK DURING COVID-19
The latest update (18th April 2020 published 23.4.20) from NHSE & I can be seen here and include links to other resources for this cohort of patients.
Guidance from NHSE (9th April) details how practices can "add" patients to the the highest risk category as defined within the guidance and can be seen at Annex 2 and the coding details for each clinical system to enable this can be found in Annex 4. NHS Digital will pick up this coding each week and up date the national lists for dissemination.
There has been alot of confusion about whether or not splenectomy patients should be on the shielded list. It was confirmed in the PC Bulletin of 23rd April that these patients should be on the shielded list and detailed as follows:-
Splenectomy patients
There have been mixed messages about whether patients who have had a splenectomy should be included on the shielded patients list (SPL). We can confirm that splenectomy patients should be included in the Shielded Patient List. These patients were identified in the central searches carried out by NHS Digital and were contacted by letter by NHS England and NHS Improvement to recommend that they follow shielding advice. Any patient with splenectomy who has been taken off the SPL should be contacted to inform them of this error. NHS Digital will be able to identify these patients centrally from 29 April 2020 and will write to practices with this information.
Renal Patients
A further update in the PC Bulletin of 27th April advises that renal patients are confirmed, by the Chief Medical Officer, as being added to the shielding list. Where they have not already done so, Renal units will get in touch with patients, send them a letter and add them to the Shielded Patient List via the regular trust submissions to NHS Digital. GPs are asked to note this update, but no further action is required at this point.
Updated shielded lists as at 5.5.20 via the PC Bulletin
The latest update of the Shielded Patient List, based on the NHS Digital GP Extraction Service, has identified a small number of patients who will be advised to shield via a centrally generated letter and text message. Flags will be added to the GP records for these patients along with patients identified by hospital clinicians this week. The addition of flags and distribution of central letters is expected to be complete by Thursday 7 May.
Any patients you locally identified as clinically extremely vulnerable prior to 28 April should now be recognised by the Government support website. Thank you for informing all of these patients, using the standard letter previously provided. If you have not done so, please ensure that you write to these patients as soon as possible. Please use the updated NHSE template letter that is currently advising people who are clinically extremely vulnerable to shield until 30 June, subject to ongoing review. People who you have identified locally and added to the registry will be sent text messages later this week and contacted early next week by the Government support service call centre if they have not yet registered online or by phone. It is therefore important that you have contacted them to confirm that they have been identified as clinically extremely vulnerable.
The Government is currently advising people to shield until at least the 30 June (irrespective of when the letter from the NHS was received) and is regularly monitoring this position.
On an ongoing basis, there will be a small number of patients who need to be added to the list as they become sick. Those who have time-bound conditions (e.g. patients receiving chemotherapy) may need to be removed from the list. Clinical decisions should continue to be taken based on the criteria set by the Chief Medical Officer and following a conversation with the patient. There should be no automated processes to complement or supplement individual clinical identification other than that used by NHS Digital.
A template letter is now available for practices to use for those patients who have self identified as needing to shield, however, on review, the patient doesn't met the criteria and needs advising that they will not be added to the official shielding list.
NHSE have produced FAQs documents for both Clinicians and Patients specifically related to the vulnerable groups. These can be seen on their website here and include a copy of the shielding letter. Gov.uk also have a guidance page on shielding and protecting the most vulnerable patients.
We have produced an overview document that shows what practices need to be do for their highest risk patients. Please click on the image below to download and print if required.
NHS Digital also has webpages specifically for guidance to general practice on the shielded patients lists. It goes into details about the criteria of lists, how to flag and a link to the template letter. It also has the following information for patients:-
I have not received a text or letter but I think I should be in the shielded patient list
Letters are being being sent out to the additional patients identified in the April run of the algorithm. We also expect doctors and hospitals to add more patients to the list as we have not been able to identify everyone. You should continue to follow advice for shielded patients on nhs.uk.
If you have not received a letter, but think you should be in the shielded patients list, you should speak to your GP or specialist.
You should also register yourself for support on the gov.uk website if you need extra help and support.
I have received a text or letter and I do not think I should be in the shielded patient list
If you are not in one of the patient groups listed above, you can ignore the communication.
If you are unsure whether you are in one of the groups listed above contact your GP or clinical specialist for advice.
Your GP or hospital can deduct you from the list once they are satisfied you are not in a high risk group.
